20 Questions
What is the term used to describe the separation of the placenta from its implantation site before delivery?
Placental abruption
How does Latin translate the term 'abruptio placentae'?
Rending asunder of the placenta
Which of the following is NOT one of the three placental disorders mentioned in the text?
Placenta separation disorder
What is the approximate rate of blood flow through the intervillous space at term, as mentioned in the text?
600 mL/min
Which placental disorder is described as being more common now than in previous years, posing a substantial threat to maternal well-being?
Placental accreta spectrum
'Premature separation of the normally implanted placenta' is described as what?
'Premature separation' term is most descriptive
'Hemorrhage following partial or complete separation of the placenta can be torrential' implies what about this type of hemorrhage?
'Torrential' implies rapid and copious hemorrhage.
Where does the blood and clots dissect to reach in a partial placental abruption?
Between membranes and decidua
What is the main source of blood in a retroplacental hematoma in a nontraumatic placental abruption?
Maternal
What percentage of women with a nontraumatic placental abruption at Parkland Hospital had fetal-to-maternal hemorrhage documented?
20 percent
Why is fetal-to-maternal hemorrhage less common in nontraumatic placental abruptions?
Placental villi are usually initially intact
What is a distinguishing feature of total placental abruption shown on the left in the schematic?
Concealed hemorrhage
Which area does the blood and clots dissect through in a partial placental abruption?
Membranes and decidua
What does the main source of hemorrhage derive from in nontraumatic placental abruptions?
Separation within maternal decidua
What is the initial event likely to trigger placental abruption?
Rupture of a decidual spiral artery
How does a decidual hematoma contribute to placental abruption?
It compresses the adjacent placenta
What condition may predispose some cases of placental abruption according to Brosens, 2011?
Atherosis due to impaired trophoblastic invasion
Why can histological findings not determine the timing of placental abruption?
The abruption process is not reflected in histology
What happens when bleeding insinuates itself between the membranes and uterine wall during placental abruption?
It eventually causes external hemorrhage through the cervix
Why is delayed diagnosis more common in cases of concealed hemorrhage during placental abruption?
'The bleeding is often misinterpreted as normal pregnancy discharge'
Study Notes
Placental Abruption
- Abruptio placentae is the term used to describe the separation of the placenta from its implantation site before delivery, and it translates to "breaking off" in Latin.
- It is a type of placental disorder that poses a substantial threat to maternal well-being.
Characteristics of Placental Abruption
- Premature separation of the normally implanted placenta is a distinguishing feature of placental abruption.
- Hemorrhage following partial or complete separation of the placenta can be torrential.
- In a partial placental abruption, the blood and clots dissect through the decidua basalis to reach the intervillous space.
- The main source of blood in a retroplacental hematoma in a nontraumatic placental abruption is the maternal circulation.
Fetal-to-Maternal Hemorrhage
- Fetal-to-maternal hemorrhage is less common in nontraumatic placental abruptions due to the separation of the placenta from the maternal circulation.
- Approximately 14% of women with a nontraumatic placental abruption at Parkland Hospital had fetal-to-maternal hemorrhage documented.
Total Placental Abruption
- A distinguishing feature of total placental abruption is the complete separation of the placenta from the uterine wall.
Pathophysiology of Placental Abruption
- The initial event likely to trigger placental abruption is the formation of a decidual hematoma.
- A decidual hematoma contributes to placental abruption by accumulating between the placenta and uterine wall, causing the placenta to separate.
- Chronic hypertension may predispose some cases of placental abruption according to Brosens, 2011.
Diagnosis and Complications
- Histological findings cannot determine the timing of placental abruption.
- When bleeding insinuates itself between the membranes and uterine wall during placental abruption, it can cause a concealed hemorrhage.
- Delayed diagnosis is more common in cases of concealed hemorrhage during placental abruption due to the lack of visible bleeding.
Test your knowledge on hemorrhagic placental disorders as discussed in Chapter 43 of Williams Obstetrics, 26th edition. Questions cover topics such as placental abruption, placenta previa, and placenta accreta spectrum.
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